There are multiple safety issues that affect the aging adult: two of the most common and serious that are of immediate concern to the healthcare professional are elder abuse and falls.
Elder abuse is a pervasive and serious safety issue for aging adults. According to the National Council on Aging, approximately 1 of every 10 Americans 60 years of age or older have experienced elder abuse, and it has been estimated that only 1 out of 14 cases of elder abuse are reported.25
Elder abuse has been defined in different ways, but it is typically considered to be intentional actions that either cause harm or a risk of harm done by a caregiver or someone in a position of trust.25 There are five types of elder abuse, listed and defined below.26
- Financial exploitation: Misusing and or exploiting an older adult’s financial resources.
- Neglect: Failing to provide the necessities of life.
- Physical abuse: Inflicting injury or pain.
- Psychological abuse: Threats, verbal assault, harassment, intimidation.
- Sexual abuse: Nonconsensual touching or sexual activities.
Factors that increase the risk for elder abuse include, but are not limited to, advanced age, female gender, dementia, inability to provide self-care, and characteristics of the caretaker.25,26,27 Signs of elder abuse vary depending on the type of abuse. For example, physical abuse can be characterized by bruises, burns, fractures or pressure ulcers; neglect by weight loss, unexplained illnesses, or an unexplained worsening of a chronic health condition.27 Screening patients for elder abuse is recommended by several professional organizations, but there is no evidence that this screening is helpful or effective.28 Screening tools that can be used include the Brief Abuse Screen for the Elderly (BASE) and the Elder Assessment Instrument (EAI).27
A fall is described as an unexpected event in which someone comes to rest on the floor or the ground.29 Falls are a common event in older adults, and it has been estimated that falls occur in 40% of adults 65 years of age and older. The incidence is higher for residents of long-term care facilities and adults over age 75.29 There are multiple risk factors that contribute to falls in the elderly, including (but not limited to) 29:
- medical conditions like dementia or stroke
- adverse effects of medications
- the use of specific medications that cause CNS depression
- orthostatic hypotension or affect balance
- advanced age
- living alone
- sedentary lifestyle
- muscle weakness and impaired vision
- environmental hazards.
Falls in the elderly can cause serious injuries and other consequences like impaired mobility, and a fall assessment is recommended for all older adults, at least once a year, and more frequently for at-risk patients.29,30 Screening involves questioning about fall history, e.g., do you have difficulty with balance or gait, have you had a fall in the past 12 months; if the patient or caretaker report positively to the questions, a more formal fall assessment can be done and there are several well-validated screening tests for fall assessment like the Timed Get Up and Go.29,30
Fall prevention strategies can prevent falls, and given the multitude of possible causes, the interventions are done on a case-by-case basis. The patient may need a medication review and adjustment; exercise has been shown to reduce the risk of falls; the patient may need a psychologic intervention, or an environmental intervention is necessary.29,31